Published on 13/5/2020
Dr Chris Perkins discusses some of the alternative medicines that have been suggested as being useful for dementia.
When speaking of “alternative” treatments we are usually talking about non-standard treatments, those not prescribed by doctors. With a condition like dementia, that can be devastating and for which there is no cure, there are bound to be many people offering untested or unproven remedies. Some will be doing this with a genuine belief that what they are suggesting will be helpful (and it might be); others could be “snake-oil salesmen” preying on desperate families.
Often a “break though” is reported in the Press, raising hopes, only to have them dashed when proper testing shows that the treatment is not effective or even harmful. It pays to take any new “cure” with a grain of salt! There are so many different causes of dementia that it is unlikely that one drug or particular therapy will cure them all. However, some herbal and other remedies have been shown scientifically to help somewhat in some areas, and provided they are not dangerous or incredibly expensive, it could be worth trying them.
As herbal supplements may interact with other medication, it is worth ensuring that they are compatible with the routine drugs that the person with dementia is taking, in particular antidiabetic medication, sedatives, antidepressants, diuretics, digoxin, cyclosporine, some HIV treatments and warfarin.
It is not possible in one small article to go through all the alternative therapies available. I will not discuss non-drug, non-herbal remedies such as various psychological therapies, diet, mental and physical exercise etc. some of which appear effective. Below I have listed some therapies that may be helpful- though most still require more testing- and those recently being promoted.
Aromatherapy: The most widely used aromatherapy oils are lavender and lemon balm applied by massage or inhaled. There is some evidence that lavender or lemon balm oil reduces agitation and improves sleep in severe dementia.
Ginkgo biloba: (20-400mg). Although early testing of Ginkgo suggested it might be helpful to slow the progression of (especially) vascular dementia, later research has showed inconsistent results.
Ginseng: has few adverse effects, but again there is no convincing evidence that it affects dementia progress.
Melatonin: Melatonin (dose 1-3 mg) may help with mood, sleep and “sun-downing” but has been investigated only in small samples for short periods of time hence needs more testing. It sometimes causes depression and does not improve cognition.
St John’s Wort or hypericum, (300mg): Depression is common in dementia and reduces function and quality of life. It has been shown to work in mild depression in people without dementia and may help people with dementia (though no trials done to date). Adverse effects are relatively uncommon but care needs to be taken when used with other medication.
Huperzine A (0.2mg) is a naturally occurring substance, extracted from a Chinese herb that works like a cholinesterase inhibitor (e.g. donepezil). Studies have been inadequate in numbers and length of time, but some have shown mild improvements in cognition, mood and behaviour. There is currently no evidence for its use in vascular dementia.
Vitamins: Vitamins A and E (tocopherol) are antioxidants and it is proposed that these reduce the rate of brain ageing and dementia progression. There is little evidence that they help, though they do not do any harm. Vitamin D is said to improve mood and cognition in older people, though it is too early to say how much it helps in dementia. Vitamin B complex will help to prevent the onset of alcohol-related brain damage. Vitamin B12 deficiency can cause neurological damage and so replacing it can prevent brain damage.
Valerian: This might be useful for insomnia (300-400mg), but has not been studied in people with dementia. It should not be used with other sedating drugs.
Finally, as I write this article (Feb 2017) the current interest is in
Coconut oil: the idea behind this is that in Alzheimer’s disease, the brain does not use glucose properly as a fuel. Caprylic acid, an expensive compound derived from palm kernel and coconut oil results in the production of ketones that the brain can use instead of glucose. A small trial showed improvement in cognitive scores after a few months of treatment and “caprilidene” became available on prescription in the USA. However, because of its cost and limited availability people have looked for alternatives, hence the interest in coconut oil. Anecdotal reports suggest that it has helped some people, but currently there is no clinical evidence that it works. The dose is 40-90ml (6 tbsp) / day of extra virgin coconut oil. The side-effects are gastro-intestinal upsets, cramping and diarrhoea.
Professor Dale Bredesen’s Alzheimer’s treatment: Promoted in New Zealand by Dr Dave Jenkins (see Listener 30/08/2016). This is a complex dietary and lifestyle regime that according to Dr Bredesen may reverse early cognitive impairment and prevent the onset of dementia in people at risk. It involves changes to sleep, exercise, diet (including supplements) and stress reduction. There is a total of 36 potentially-helpful elements all up, and none of these are new. However, this treatment has yet to be rigorously scientifically evaluated and it is expensive, costing $400 to $20,000 per year according to The Listener. Perhaps the best option here is to await more results, due out this year, and continue activities that have been proven helpful i.e. physical and mental stimulation, socialisation, managing vascular risk factors (diabetes, high blood pressure), reducing stress, eating a sensible diet, not drinking excessively or smoking.
To summarise, some alternative therapies may help some people some of the time with some symptoms. Most have not been scientifically-proven. However, provided they do not cause adverse effects or cost too much, they could be worth trying. For further scientific information about many more dementia therapies in understandable language see: www.cochrane.org/search/site/dementia%20treatment
This article originally appeared in Mind Matters, the newsletter of Dementia Auckland
About the author
After working in General Practice Chris trained in psychiatry, specialising in mental health for older people. She has worked in this area for nearly 30 years with a particular interest in dementia. She is the author of books on dementia (The New Zealand Dementia Guide (2004), revised 2006, Dementia, What you need to know (2013), Random House / Penguin).